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

Selekoksib’den hareketle sülfoniltiyoüre ve türevlerinin sentezi

ÖZET Selektif COX-2 enzim inhibitörü olarak kullanılan Selekoksib’in, NSAİİ özelliğinin yanı sıra antikanser özelliği de açıklanmıştır. Selekoksib gibi pirazol yapısı taşıyan bileşiklerin de antikanser, anti-HCV ve antienflamatuvar etkisi kanıtlanmıştır. Yapılan çalışmalarda sülfoniltiyoürelerin ve tiyazolidon halkası taşıyan bileşiklerin antibakteriyel, antikonvülsan, antienflamatuvar, antikanser ve antidiyabetik vb. etkisi olduğu bilinmektedir. Laboratuvarımızda sentezlenen tiyoüre ve tiyazolidon yapısı taşıyan bileşiklerin belirtilen farmakolojik etkilere sahip oluşu, bize yeni bileşiklerin sentezini düşündürmüştür. Bu araştırmada Selekoksib’den hareketle sübstitüe izotiyosiyanat ve kuru K2CO3 kullanarak, kuru asetonlu ortamda N-(sübstitüekarbamotiyoil)-4-[5-(4-metilfenil)-3-(trifluorometil)-1H-pirazol-1-il]benzensülfonamit [1a-e] ve sentezlenen bu bileşikler etil -bromoasetat ile susuz sodyum asetat varlığında kuru etanollü ortamda, N-(3-sübstitüe-4-okso-1,3-tiyazolidin-2-iliden)-4-[5-(4-metilfenil)-3-(trifluorometil)-1H-pirazol-1-il]benzen sülfonamit [2a-e] türevleri sentezlenmiştir. Bileşiklerin bazıları ‘Yeşil Kimya’ olarak bilinen mikrodalga destekli sentez yöntemi kullanılarak elde edilmiştir. Mikrodalga radyasyonunun kullanımı ile çözücü, zaman ve enerji tasarrufu sağlanmıştır. Sentezlenen bileşiklerin saflıkları ince tabaka kromatografisi ile kontrol edildikten sonra, yapıları elementel analiz ve spektral (UV, IR, 1H-NMR, 13C-NMR, HR-MS gibi) verilerle aydınlatılmıştır. Elde edilen bileşiklerden seçilmiş olanların antikanser etkileri NIH (National Institues of Health) Araştırma Merkezi’nde, hepatit C NS5B polimeraz enzim inhibisyon etkinlikleri UMDNJ-New Jersey Medical School’da Biyokimya ve Moleküler Biyoloji Bölümü’nde çalışılmıştır. Ayrıca, bileşiklerin antienflamatuvar ve analjezik aktiviteleri, gastrik ülserasyon çalışmaları ve lipid peroksidasyon testleri İnönü Üniversitesi Eczacılık Fakültesi Farmakoloji Bölümü’nde çalışılmıştır. Anahtar Kelime: Antienflamatuvar aktivite, Hepatit C NS5B, Selekoksib, Sülfoniltiyoüre, Sülfoniliminotiyazolidon SUMMARYSynthesis of Sulfonylthiourea and Derivatives from CelecoxibİNCİ COŞKUN Celecoxib which is used as a selective inhibitor of COX-2 enzyme described to show anticancer effects as well as NSAIDs property. Such as celecoxib, pyrazol compounds with the structure of the anticancer and anti-HCV and antiinflammatory effect has been proved. Studies have been reported that sulfonylthioureas and thiazolidinones possess antibacterial, anticonvulsant, anti-inflammatory, anticancer and antidiabetic etc. activities. Thioureas and thiazolidinones, which were synthesized in our laboratory had also been shown to demonstrate the activities mentioned above, motivated us about the design and synthesis of new compounds. In this study, N-(substituted carbamothioyl)-4-[5-(4-methylphenyl)-3-(trifluoromethyl)-1H-pyrazol-1-yl]benzenesulfonamides [1a-e] were prepared with substituted isothiocyanate and dry K2CO3 in dry acetone starting from celecoxib. N-(3-Substituted-4-oxo-1,3-thiazolidine-2-ylidene)-4-[5-(4-methylphenyl)-3-(trifluoromethyl)-1H-pyrazol-1-yl]benzenesulfonamide [2a-e] derivatives were synthesized by the reaction of ethyl -bromoacetate and anhydrous sodium acetate in dry ethanol with the sulfonylthioureas [1a-e]. Some of the compounds were obtained by microwave assisted synthesis method which is also known as Green Chemistry. By using microwave radiation, solvent, time and energy saving were provided. After purities of the synthesized compounds were controlled with TLC, structures of the compounds were confirmed by elemental analysis and spectral (UV, IR, 1H-NMR, 13C-NMR, HR-MS etc.) data. The anticancer activity of the selected compounds was elucidated in NIH (National Institutes of Health) and the Hepatitis C NS5B polimerase enzyme inhibition efficacy of all compound was laboured in the Department of Biochemistry and Molecular Biology of New Jersey Medical School- UMDNJ. Also, analgesic and antiinflammatory activities, gastric ulserogenic studies and lipid peroxidation tests of the compounds were tested in the Department of Pharmacology at Inonu University. Key Words: Antiinflammatory activity, Hepatitis C NS5B, Celecoxib, Sulfonylthiourea, Sulfonyliminothiazolidinon

Selekoksib’den hareketle sülfoniltiyoüre ve türevlerinin sentezi

Selektif COX-2 enzim inhibitörü olarak kullanılan Selekoksib’in, NSAİİ özelliğinin yanı sıra antikanser özelliği de açıklanmıştır. Selekoksib gibi pirazol yapısı taşıyan bileşiklerin de antikanser, anti-HCV ve antienflamatuvar etkisi kanıtlanmıştır. Yapılan çalışmalarda sülfoniltiyoürelerin ve tiyazolidon halkası taşıyan bileşiklerin antibakteriyel, antikonvülsan, antienflamatuvar, antikanser ve antidiyabetik vb. etkisi olduğu bilinmektedir. Laboratuvarımızda sentezlenen tiyoüre ve tiyazolidon yapısı taşıyan bileşiklerin belirtilen farmakolojik etkilere sahip oluşu, bize yeni bileşiklerin sentezini düşündürmüştür. Bu araştırmada Selekoksib’den hareketle sübstitüe izotiyosiyanat ve kuru K2CO3 kullanarak, kuru asetonlu ortamda N-(sübstitüekarbamotiyoil)-4-[5-(4-metilfenil)-3-(trifluorometil)-1H-pirazol-1-il]benzensülfonamit [1a-e] ve sentezlenen bu bileşikler etil -bromoasetat ile susuz sodyum asetat varlığında kuru etanollü ortamda, N-(3-sübstitüe-4-okso-1,3-tiyazolidin-2-iliden)-4-[5-(4-metilfenil)-3-(trifluorometil)-1H-pirazol-1-il]benzen sülfonamit [2a-e] türevleri sentezlenmiştir. Bileşiklerin bazıları ‘Yeşil Kimya’ olarak bilinen mikrodalga destekli sentez yöntemi kullanılarak elde edilmiştir. Mikrodalga radyasyonunun kullanımı ile çözücü, zaman ve enerji tasarrufu sağlanmıştır. Sentezlenen bileşiklerin saflıkları ince tabaka kromatografisi ile kontrol edildikten sonra, yapıları elementel analiz ve spektral (UV, IR, 1H-NMR, 13C-NMR, HR-MS gibi) verilerle aydınlatılmıştır. Elde edilen bileşiklerden seçilmiş olanların antikanser etkileri NIH (National Institues of Health) Araştırma Merkezi’nde, hepatit C NS5B polimeraz enzim inhibisyon etkinlikleri UMDNJ-New Jersey Medical School’da Biyokimya ve Moleküler Biyoloji Bölümü’nde çalışılmıştır. Ayrıca, bileşiklerin antienflamatuvar ve analjezik aktiviteleri, gastrik ülserasyon çalışmaları ve lipid peroksidasyon testleri İnönü Üniversitesi Eczacılık Fakültesi Farmakoloji Bölümü’nde çalışılmıştır. Anahtar Kelime: Antienflamatuvar aktivite, Hepatit C NS5B, Selekoksib, Sülfoniltiyoüre, Sülfoniliminotiyazolidon SUMMARY Synthesis of Sulfonylthiourea and Derivatives from Celecoxib İNCİ COŞKUN Celecoxib which is used as a selective inhibitor of COX-2 enzyme described to show anticancer effects as well as NSAIDs property. Such as celecoxib, pyrazol compounds with the structure of the anticancer and anti-HCV and antiinflammatory effect has been proved. Studies have been reported that sulfonylthioureas and thiazolidinones possess antibacterial, anticonvulsant, anti-inflammatory, anticancer and antidiabetic etc. activities. Thioureas and thiazolidinones, which were synthesized in our laboratory had also been shown to demonstrate the activities mentioned above, motivated us about the design and synthesis of new compounds. In this study, N-(substituted carbamothioyl)-4-[5-(4-methylphenyl)-3-(trifluoromethyl)-1H-pyrazol-1-yl]benzenesulfonamides [1a-e] were prepared with substituted isothiocyanate and dry K2CO3 in dry acetone starting from celecoxib. N-(3-Substituted-4-oxo-1,3-thiazolidine-2-ylidene)-4-[5-(4-methylphenyl)-3-(trifluoromethyl)-1H-pyrazol-1-yl]benzenesulfonamide [2a-e] derivatives were synthesized by the reaction of ethyl -bromoacetate and anhydrous sodium acetate in dry ethanol with the sulfonylthioureas [1a-e]. Some of the compounds were obtained by microwave assisted synthesis method which is also known as Green Chemistry. By using microwave radiation, solvent, time and energy saving were provided. After purities of the synthesized compounds were controlled with TLC, structures of the compounds were confirmed by elemental analysis and spectral (UV, IR, 1H-NMR, 13C-NMR, HR-MS etc.) data. The anticancer activity of the selected compounds was elucidated in NIH (National Institutes of Health) and the Hepatitis C NS5B polimerase enzyme inhibition efficacy of all compound was laboured in the Department of Biochemistry and Molecular Biology of New Jersey Medical School- UMDNJ. Also, analgesic and antiinflammatory activities, gastric ulserogenic studies and lipid peroxidation tests of the compounds were tested in the Department of Pharmacology at Inonu University. Key Words: Antiinflammatory activity, Hepatitis C NS5B, Celecoxib, Sulfonylthiourea, Sulfonyliminothiazolidinon

Investor relations as a tool for efficient communications with financial markets and advanced transparency

Finansal piyasalarda işlem gören varlık fiyatlarının bileşeni olan bilginin elde edilmesi ve değerlendirilmesi finansal piyasaların en temel fonksiyonudur. İşletmelere ilişkin finansal piyasa algısının oluşumunda işletmenin verdiği bilgilerin niteliği ve niceliği etkili olmaktadır. Çalışmada anlık, doğru, kolaylıkla anlaşılabilir, karşılaştırılabilir, şeffaf, finansal olmayan bilgileri de kapsayan, güvenilir ve süreklilik gösteren bir bilgilendirme politikasının finansal piyasaların katılımcılarında işletmeye yönelik güven inşa edilmesine katkısı incelenmektedir. İşletmeye yönelik güven oluşumunu sağlayacak etkin bir iletişim ve geliştirilmiş şeffaflık aracı olarak Yatırımcı İlişkileri değerlendirilmektedir. Yatırımcı ilişkileri yönetimi kapsamındaki faaliyetlerin işletme ve finansal piyasalara katkıları ortaya konmaktadır.Obtainment and evaluation of information which is a component of price of assets traded in financial markets is the most principle of financial market functions. The quantity and quality of information disseminated by the business are effective in forming financial markets’ perceptions about a corporation. This study examines the contribution of a prompt, accurate, clear, transparent, reliable and consistent disclosure policy that also includes nonfinancial information on establishing trust for financial market investors towards the corporation. Investor relations management is evaluated as a tool for efficient communications and advanced transparency to ensure building of trust towards the corporation. The contributions of activities within the scope of investor relations management towards the corporation and financial markets are identified

FİNANSAL PİYASALAR İLE ETKİN BİR İLETİŞİM VE GELİŞTİRİLMİŞ ŞEFFAFLIK ARACI OLARAK YATIRIMCI İLİŞKİLERİ

Finansal piyasalarda işlem gören varlık fiyatlarının bileşeni olan bilginin elde edilmesi ve değerlendirilmesi finansal piyasaların en temel fonksiyonudur. İşletmelere ilişkin finansal piyasa algısının oluşumunda işletmenin verdiği bilgilerin niteliği ve niceliği etkili olmaktadır. Çalışmada anlık, doğru, kolaylıkla anlaşılabilir, karşılaştırılabilir, şeffaf, finansal olmayan bilgileri de kapsayan, güvenilir ve süreklilik gösteren bir bilgilendirme politikasının finansal piyasaların katılımcılarında işletmeye yönelik güven inşa edilmesine katkısı incelenmektedir. İşletmeye yönelik güven oluşumunu sağlayacak etkin bir iletişim ve geliştirilmiş şeffaflık aracı olarak Yatırımcı İlişkileri değerlendirilmektedir. Yatırımcı ilişkileri yönetimi kapsamındaki faaliyetlerin işletme ve finansal piyasalara katkıları ortaya konmaktadır

Investor Relations As A Tool For Efficient Communications With Financial Markets And Advanced Transparency

Finansal piyasalarda işlem gören varlık fiyatlarının bileşeni olan bilginin elde edilmesi ve değerlendirilmesi finansal piyasaların en temel fonksiyonudur. İşletmelere ilişkin finansal piyasa algısının oluşumunda işletmenin verdiği bilgilerin niteliği ve niceliği etkili olmaktadır. Çalışmada anlık, doğru, kolaylıkla anlaşılabilir, karşılaştırılabilir, şeffaf, finansal olmayan bilgileri de kapsayan, güvenilir ve süreklilik gösteren bir bilgilendirme politikasının finansal piyasaların katılımcılarında işletmeye yönelik güven inşa edilmesine katkısı incelenmektedir. İşletmeye yönelik güven oluşumunu sağlayacak etkin bir iletişim ve geliştirilmiş şeffaflık aracı olarak Yatırımcı İlişkileri değerlendirilmektedir. Yatırımcı ilişkileri yönetimi kapsamındaki faaliyetlerin işletme ve finansal piyasalara katkıları ortaya konmaktadır.Obtainment and evaluation of information which is a component of price of assets traded in financial markets is the most principle of financial market functions. The quantity and quality of information disseminated by the business are effective in forming financial markets’ perceptions about a corporation. This study examines the contribution of a prompt, accurate, clear, transparent, reliable and consistent disclosure policy that also includes nonfinancial information on establishing trust for financial market investors towards the corporation. Investor relations management is evaluated as a tool for efficient communications and advanced transparency to ensure building of trust towards the corporation. The contributions of activities within the scope of investor relations management towards the corporation and financial markets are identified

Pelvic Actinomycosis Causing Acute Abdominal Pain in an Elderly Patient in the Postmenopausal Period

Pelvic actinomycosis, which is a rarely seen disease, is caused by an anaerobic gram-positive organism, Actinomyces israelii, and usually occurs in patients with intrauterine device. It is chronic, granulomatous, suppurative and prone to fistulization. A 73-years-old patient with acute abdominal pain was operated, and perforated left tubo-ovarian abscess was seen. In the operation, left salpingo-oophorectomy, partial omentectomy and appendectomy were performed. She had diabetes mellitus type-2, which is a risk factor. She had no history of vaginal tablet use and was treated with penicillin for a long period. We aimed to discuss a pelvic actinomyces case seen in the eighth decade of life, without use of intrauterine device, and which resulted in pelvic peritonitis

The effect of motivational video and nutrition on the non-stress test: a randomised controlled clinical trial

This study aimed to determine the effect of motivational video stimulation and nutrition on the non-stress test (NST). The sample of the study consisted of 360 pregnant women in total, including two experimental groups and one control group (120 pregnant women in each group). After the pregnant women in the study were divided into three groups at a 1:1:1 ratio with the computer-assisted random sampling method, the draw method was used to determine the experimental and control groups. The pregnant women in the first experimental group were allowed to consume cake and juice 30 min before the NST procedure. The pregnant women in the second experimental group were also allowed to consume cake and juice, while they were also shown a video with the content of development and changes in the mother and the foetus during pregnancy, with relaxing music, for about 15–20 min. There was no intervention made in the control group. The data were collected using a Participant Information Form and an NST Findings Registry Form which were created by the researchers based on their review of the relevant literature. The data were analysed using arithmetic means, percentage distributions, ANOVA, Bonferroni and chi-squared tests. It was found that the mean number of foetal movements and the mean number of accelerations in the cake + juice and motivational video groups were higher than those in the control group (p < 0.001). Besides, the pregnant women in the experimental groups were found to have more reactive NST results. As a result, it was determined that the motivational video and cake + juice interventions improved the movement of the foetus, the number of accelerations and the ratio of reactivity in NST, but the two interventions did not have any superiority over each other. It is recommended to offer cake and juice to pregnant women before NST or have them watch a motivational video during NST, for having good NST results.Impact statement What is already known about the topic? The false-positive rates of the NST, which enables monitoring foetal movements and foetal heart rates, are high. These false-positive rates of the NST lead to many obstetric complications, in addition to increasing the rates of cesarean-section deliveries. Recent studies showed that there are methods and factors that increase foetal movements and shorten the application period of the NST. It was identified that food intake, music therapy, foetal vibroacoustic and halogen light stimulation before the NST increases foetal movements and shortens the application period of the NST. What this paper adds? In the study, it was found that watching motivational videos and consuming cake and juice increased the number of foetal movements, the number of accelerations and the rate of reactive NST results, but the two interventions did not have superiority over each other. What are the implications of these findings for clinical practice and/or further research? In order to increase reactive NST rates, it is recommended that pregnant women consume cake and fruit juice before the procedure and watch a motivational video during the NST procedure