Urolithiasis in childhood and prevention

Pediatric stone disease is a frequently underestimated entity that can present unique problems in its management. Children can present with stones at any age (premature newborn to teenager). Urolithiasis stems from various renal, urologic, endocrine and metabolic disorders. The physical examination in children with urolithiasis is influenced by several factors like age, pain, infection, and underlying process producing the stone and size, localization and passage of the stone. It should be the first step to investigate metabolic disorders (e. g. Hypercalciuria, hyperuricosuria, cystinuria, renal tubular acidosis, xanthinuria, and primary hyperoxaluria) and recurrent urinary tract infection in countries with a particularly high ratio urolithiasis like Turkey. Preventive approach to new stone formation requires a combination of medication, large fluid intake, and some dietary restrictions.Üriner sistem taş hastalığı, çocuklarda çoğunlukla gerçek sıklığından daha az tanı konulan ve önemli komplikasyonlara yol açabilen bir hastalıktır. Çocuklukta, prematüre bir yenidoğandan adolesana kadar her dönemde üriner sistem taşı görülebilir. Taşlar renal, ürolojik, endokrin veya metabolik hastalığa bağlı olarak oluşabilir. Klinik bulgular, hastanın yaşı, taşın büyüklüğü, yeri, tıkanıklığa yol açıp açmaması, taşın yer değiştirmesi, enfeksiyon varlığı ve altta yatan hastalığın bulguları ile ilişkilidir. Türkiye gibi taş hastalığının yaygın olduğu ülkelerde, tedavi ve izlemde ilk adım hiperkalsiüri, hiperürikozüri, sistinüri, renal tübüler asidoz, ksantinüri, primer hiperokzalüri gibi taşa neden olan metabolik bozukluklar ve enfeksiyonun araştırılmasıdır. Yeni taş oluşumunun önlenmesi tıbbi tedavi, diyet ve sıvı alımını içeren koruyucu önlemlerin alınması ile mümkündür

Play, toy and children

Oyun ve onun aracı oyuncak çocuğun hayatının önemli bir kısmını oluşturur; kişilik ve yeteneklerini geliştirmesine fırsat yaratarak onu erişkin dünyasına hazırlar. Gelişim basamaklarındaki ilerleyiş ile birlikte oyun ve oyuncak kavramında ve seçiminde de değişiklikler ortaya çıkmaktadır. Çocukların sağlığından sorumlu anne babalar ve doktorlar için bu değişimin sağlıklı bir şekilde gerçekleştiğini izlemek zorunludur.Bu nedenle oyun ve oyuncak kullanımını ayrıntılı olarak değerlendirebilmek önem kazanmaktadır. Bu derlemede oyun ve oyuncakların çocuk mental ve fizik sağlığına etkileri ve özellikle oyuncak seçiminde dikkat edilmesi gereken noktaları özetlemeyi amaçladık.Play and toys as its tools complement an important aspect of children's lives and prepare them to the adult world by allowing their personality and skills to improve. Preferences and meaning of different types of play and toys change as the child progresses on developmental steps. For parents and doctors responsible for the child's health, it is an obligation to confirm that this change occurs properly. Therefore it is essential to gain the ability to evaluate the use of toys and play in detail. In this review article, we aimed to summarize the effects of play and toys on mental and physical health of children and the important points about choice of toys

Antimicrobial resistance among migrants in Europe: a systematic review and meta-analysis

BACKGROUND: Rates of antimicrobial resistance (AMR) are rising globally and there is concern that increased migration is contributing to the burden of antibiotic resistance in Europe. However, the effect of migration on the burden of AMR in Europe has not yet been comprehensively examined. Therefore, we did a systematic review and meta-analysis to identify and synthesise data for AMR carriage or infection in migrants to Europe to examine differences in patterns of AMR across migrant groups and in different settings. METHODS: For this systematic review and meta-analysis, we searched MEDLINE, Embase, PubMed, and Scopus with no language restrictions from Jan 1, 2000, to Jan 18, 2017, for primary data from observational studies reporting antibacterial resistance in common bacterial pathogens among migrants to 21 European Union-15 and European Economic Area countries. To be eligible for inclusion, studies had to report data on carriage or infection with laboratory-confirmed antibiotic-resistant organisms in migrant populations. We extracted data from eligible studies and assessed quality using piloted, standardised forms. We did not examine drug resistance in tuberculosis and excluded articles solely reporting on this parameter. We also excluded articles in which migrant status was determined by ethnicity, country of birth of participants' parents, or was not defined, and articles in which data were not disaggregated by migrant status. Outcomes were carriage of or infection with antibiotic-resistant organisms. We used random-effects models to calculate the pooled prevalence of each outcome. The study protocol is registered with PROSPERO, number CRD42016043681. FINDINGS: We identified 2274 articles, of which 23 observational studies reporting on antibiotic resistance in 2319 migrants were included. The pooled prevalence of any AMR carriage or AMR infection in migrants was 25·4% (95% CI 19·1-31·8; I2 =98%), including meticillin-resistant Staphylococcus aureus (7·8%, 4·8-10·7; I2 =92%) and antibiotic-resistant Gram-negative bacteria (27·2%, 17·6-36·8; I2 =94%). The pooled prevalence of any AMR carriage or infection was higher in refugees and asylum seekers (33·0%, 18·3-47·6; I2 =98%) than in other migrant groups (6·6%, 1·8-11·3; I2 =92%). The pooled prevalence of antibiotic-resistant organisms was slightly higher in high-migrant community settings (33·1%, 11·1-55·1; I2 =96%) than in migrants in hospitals (24·3%, 16·1-32·6; I2 =98%). We did not find evidence of high rates of transmission of AMR from migrant to host populations. INTERPRETATION: Migrants are exposed to conditions favouring the emergence of drug resistance during transit and in host countries in Europe. Increased antibiotic resistance among refugees and asylum seekers and in high-migrant community settings (such as refugee camps and detention facilities) highlights the need for improved living conditions, access to health care, and initiatives to facilitate detection of and appropriate high-quality treatment for antibiotic-resistant infections during transit and in host countries. Protocols for the prevention and control of infection and for antibiotic surveillance need to be integrated in all aspects of health care, which should be accessible for all migrant groups, and should target determinants of AMR before, during, and after migration. FUNDING: UK National Institute for Health Research Imperial Biomedical Research Centre, Imperial College Healthcare Charity, the Wellcome Trust, and UK National Institute for Health Research Health Protection Research Unit in Healthcare-associated Infections and Antimictobial Resistance at Imperial College London

Surgical site infection after gastrointestinal surgery in high-income, middle-income, and low-income countries: a prospective, international, multicentre cohort study

Background: Surgical site infection (SSI) is one of the most common infections associated with health care, but its importance as a global health priority is not fully understood. We quantified the burden of SSI after gastrointestinal surgery in countries in all parts of the world. Methods: This international, prospective, multicentre cohort study included consecutive patients undergoing elective or emergency gastrointestinal resection within 2-week time periods at any health-care facility in any country. Countries with participating centres were stratified into high-income, middle-income, and low-income groups according to the UN's Human Development Index (HDI). Data variables from the GlobalSurg 1 study and other studies that have been found to affect the likelihood of SSI were entered into risk adjustment models. The primary outcome measure was the 30-day SSI incidence (defined by US Centers for Disease Control and Prevention criteria for superficial and deep incisional SSI). Relationships with explanatory variables were examined using Bayesian multilevel logistic regression models. This trial is registered with ClinicalTrials.gov, number NCT02662231. Findings: Between Jan 4, 2016, and July 31, 2016, 13 265 records were submitted for analysis. 12 539 patients from 343 hospitals in 66 countries were included. 7339 (58·5%) patient were from high-HDI countries (193 hospitals in 30 countries), 3918 (31·2%) patients were from middle-HDI countries (82 hospitals in 18 countries), and 1282 (10·2%) patients were from low-HDI countries (68 hospitals in 18 countries). In total, 1538 (12·3%) patients had SSI within 30 days of surgery. The incidence of SSI varied between countries with high (691 [9·4%] of 7339 patients), middle (549 [14·0%] of 3918 patients), and low (298 [23·2%] of 1282) HDI (p < 0·001). The highest SSI incidence in each HDI group was after dirty surgery (102 [17·8%] of 574 patients in high-HDI countries; 74 [31·4%] of 236 patients in middle-HDI countries; 72 [39·8%] of 181 patients in low-HDI countries). Following risk factor adjustment, patients in low-HDI countries were at greatest risk of SSI (adjusted odds ratio 1·60, 95% credible interval 1·05–2·37; p=0·030). 132 (21·6%) of 610 patients with an SSI and a microbiology culture result had an infection that was resistant to the prophylactic antibiotic used. Resistant infections were detected in 49 (16·6%) of 295 patients in high-HDI countries, in 37 (19·8%) of 187 patients in middle-HDI countries, and in 46 (35·9%) of 128 patients in low-HDI countries (p < 0·001). Interpretation: Countries with a low HDI carry a disproportionately greater burden of SSI than countries with a middle or high HDI and might have higher rates of antibiotic resistance. In view of WHO recommendations on SSI prevention that highlight the absence of high-quality interventional research, urgent, pragmatic, randomised trials based in LMICs are needed to assess measures aiming to reduce this preventable complication

Microalbumin excretion and outcome in children with multicystic dysplastic kidney

Aim: To present the long-term follow-up results of children with multicystic dysplastic kidney (MCDK) and urinary microalbumin excretion levels in order to evaluate whether there is an increased risk of renal damage or not. Materials and methods: Thirty-three children with the diagnosis of MCDK who had been followed up by the nephrology outpatient clinic between 2002 and 2009 were invited to participate in the study. Twenty-six healthy children were investigated as a control group for microalbumin/creatinine ratio (&amp;#956;g/g creatinine). The mean age at diagnosis, the duration of follow-up, accompanying urinary tract abnormalities, attacks of urinary tract infection (UTI), contralateral kidney size, and urinary microalbumin levels were investigated. Results: The mean age of the patients with MCDK and the mean duration of follow-up were 6.5 &plusmn; 3.9 years and 35 months (range 2-96) months, respectively. The most common urinary tract abnormality was vesicoureteral refl ux (VUR), with a rate of 34%. Thirty-nine percent of the children experienced UTI during follow-up. The compensatory renal hypertrophy of the contralateral kidney was 24% at 6 months and 68% at 12 months. Sixteen patients (59%) had an increased microalbumin/creatinine ratio (&gt;30 &amp;#956;g/mg creatinine). Microalbumin/creatinine ratio was higher in patients with MCDK than it was in the controls (P = 0.001). Conclusion: Microalbuminuria and VUR are not rare in children with MCDK. Systematic follow-up of these patients is recommended to identify those at risk of contralateral renal damage

Effect of cefixime treatment on urinary NAG excretion in children with urinary tract infection

İdrar yolu enfeksiyonu (İYE) çocukluk çağının en sık bakteriyel enfeksiyonlarından biridir. Üçüncü jenerasyon sefalosporinler arasında yer alan ve geniş antibakteriyal spektruma sahip olan sefiksimin İYE'nun oral yoldan tedavisinde etkinliği kanıtlanmıştır. Bu çalışmada İYE'lu çocuklarda sefiksimin idrar elektrolit atılımları ve proksimal tübüler fonksiyo¬nun duyarlı bir göstergesi olan N-asetil-beta-D-glukozaminidaz (NAG) atılımına etkisinin araştırılması amaçlanmıştır. Çalışmaya İYE tanısı konan ve sefiksim tedavisi başlanan yaşlan 5-156 ay arasında değişen (medyan yaş: 72 ay) 24 kız, 2 erkek İYE'lu çocuk çalışma grubu olarak alınırken; kontrol grubu olarak son bir ay içinde antibiyotik kullanmamış olan 17 çocuk (yaş dağılımı 8-156 ay arasında, medyan yaş 82 ay, 6 kız, 11 erkek) alınmıştır. İYE'lu hastaların sefiksim tedavisi öncesi ve 10 günlük tedaviden sonra, ayrıca kontrol grubunun açlık spot ilk idrar örneklerinde sodyum, potasyum, kalsiyum, magnezyum, ürik asit, fosfor (Na, K, Ca, Mg, Ürik Asit, P) düzeyleri ve NAG aktiviteleri ölçülerek sonuçlar idrar kreatinine (Kre) oranlanarak hesaplanmıştır. İdrar NAG aktivite ölçümü idrara jel filtrasyonu uygulandıktan sonra paranitrofenol yöntemi ile yapılmıştır. Kontrol grubu ile tedavi öncesi hasta grubunun sonuçlan non-parametrik, Mann Whitney U testi ile; hasta grubunun tedavi öncesi ve tedavi sonrası değerleri Wilcoxon Signed Ranks testi ile karşılaştınlmıştır.Çalışmanın sonuçlarında spot idrarda Na, K, Ca, Ürik Asit, Mg, P'un idrar kreatinine oranları ve NAG/Kre oranları İYE'lu çocuklarda tedavi öncesinde kontrol grubuna oranla farklı bulunmamıştır (p>0,05). İdrar elektrolit ve NAG atılımları da hasta grubunda tedavi sonrasında tedavinin başlangıç düzeylerine oranla farklı değildi (p>0,05).Sonuç olarak, oral yoldan günde tek doz olarak kullanılan ve bu şekilde tedavi uyumu yüksek olan sefiksimin renal tübüler fonksiyonlarda değişiklik yaratmadığı saptandı. Bu sonucun tedavinin güvenilirliğinin belirlenmesi açısından önemli olduğu düşünüldü.Urinary tract infections are one of the most common bacterial infections of childhood. Efficacy of cefixime, which is a third generation cephalosporin, is proven in oral treatment of urinary tract infections. The aim of this study was to evaluate the effect of cefixime, which was shown to accumulate in renal tissue at high concentrations, on the excretion of N-acetyl-beta-D-gThe study group consisted of 26 children (age range 5-156 months, median age 72 month, 24 female) who received cefixime treatment for urinary tract infection. Control group was composed of 17 children (age range 8-156 months, median age 82 month, 6 female) whose mean age was similar to that of the patient group and who had not received antibiotics in the last month. Sodium, potassium, calcium, magnesium, uric acid, phosphorus (Na, K, Ca, Mg, UA, P) and NAG levels were measured in the first morning fasting urine in the patients before and 10 days after treatment as well as in the control group and the results were calculated by dividing these values by the urinary creatinine (Cr). Urinary levels of the NAG enzyme were measured via the paranitrophenol method after gel filtration. Results of the control and pretreatment group were compared by the Mann Whitney U test. Pre- and post-treatment urinary electrolyte and urinary NAG results were compared by the Wilcoxon Signed Ranks test.Ratio of urinary Na, K, Ca, uric acid, Mg, P and NAG to creatinin in the pretreatment group were not found to be different from those of the control group (p&gt;0,05). Similarly, excretion of electrolytes and NAG did not change significantly after treatment when compared to those before treatment (p&gt;0,05).As a conclusion, cefixime, which has single oral daily dosage and therefore high patient compliance, was detected not to cause changes in renal tubular functions. This result was thought to be important in determination of the safety of the treatment.lucosaminidase (NAG) that is a sensitive marker of proximal tubular functions

Frequency of bacterial contamination of toys in different environments

Oyuncaklar çocuğun fiziksel, motor ve psikososyal gelişimi ve erişkin bir birey olmasını sağlayan oyunun ayrılmaz parçasıdır. Çok çeşitli işlevleri olan oyuncakların sağlık sakıncası oluşturmaması gerekir. Bu çalışmanın amacı farklı ortamlarda bulunan ve kullanılan oyuncaklarda patojen mikro-organizma kolonizasyonunun araştırılmasıdır. Üç hastane, 15 kreş, 25 evdeki oyuncaklardan bulundukları yerlerde alınan toplam 285 sürüntü örneğinin bakteriyolojik ve mikolojik incelemesi yapılmış ve izole edilen bakterilerin antimikrobiyal direnç özellikleri standart disk difüzyon yöntemi ile araştırılmıştır. Kültür alınan 285 oyuncağın %31'inde üreme vardı; bu oran hastaneden alınanlarda %38.6, kreşten alınanlarda %28.7 iken evden alınanlarda %23.3 olarak saptandı. Bu yerler arasındaki üreme oranlarındaki farklılık anlamlı bulundu. Tüm kültürler içinde %33.3 ile koagülaz-negatif stafilokok ve %24.1 ile Staphylococcus aureus en sık üreyen mikroorganizmalardı. Oyuncak tiplerine göre ayrıldığında; %42.8 ile en sık tüylü oyuncaklardan alınan kültürlerde üreme saptandı; bu oranın yıkanamayan oyuncaklarda %39.7 iken yıkanabilen oyuncaklarda %28.5 olduğu görüldü. Kültür alınan tüm yerlerde üreyen mikro-organizmalarda en yüksek direnç oranı %90-100 ile penisiline karşıyken en az direnç oranı ise vankomisin ve teikoplanine karşıydı. Bu oranlar göz önüne alındığında, oyuncaklarda patojen mikro-organizma saptanabileceği ve bunların hastalardan tekrar tekrar infekte olarak hasta bir çocuktan diğerine İnfeksiyon taşıyıcısı potansiyeli olabileceği görülür. Oyuncakların bu İnfeksiyon zincirindeki yeri ve günümüzde hastane infeksiyonlarmın önemi akılda tutularak hasta ya da çok sayıda çocuk tarafından kullanılan oyuncaklar açısından özel çözümler getirilmelidir.Play that is essential for physical, motor, and psychosocial development of child to become an adult requires toys as an innate tool. Toys should not be hazardous to health. The aim of this study was to search for colonisation of pathogenic microorganisms on toys in different environments. Microbial growth and antibiotic resistance in 285 cultures taken from toys used in 3 hospitals, 15 daycare centers and 25 houses were evaluated. Growth was detected in 31.6% of cultures; this rate was 39.1% in hospital toys, 26.3% in daycare center toys while 27.6 % in house toys. The difference among these values was statistically meaningful. The most common microorganisms detected were coagulase-negative staphylococci with 33.3% and Staphylococcus aureus with 24.1%. When growth was compared among different kinds of toys, it was most commonly detected in cultures taken from furry toys with 42.8%; this rate was 28.5% in washable while 39.7% in nonwashable toys. Highest resistance was against penicillin with a ratio of 90-100% while it was lowest against vancomycine and teichoplanin. It is concluded that pathogenic microorganisms can be found on toys and these toys can be infected again and again from ill children carrying the potential to transmit this infection to others. Keeping in mind the importance of nosocomial infections in today's world and the place of toys in this chain of infectious transmission, special care should be given to toys shared by many children

Do patients with neurogenic bladder treated with clean intermittent catheterization need antibacterial prophylaxis?

Background/aim: In this study, we investigated the effectiveness of antibiotic prophylaxis (ABP) with respect to the incidence of symptomatic urinary tract infections (UTIs) and evaluated the development of renal scarring in patients treated with clean intermittent catheterization (CIC). Materials and methods: A total of 22 patients were included in the study. The patients were administered ABP in the first year (the ABP-received period) but not in the second year (the ABP-discontinued period). Results: Twenty-eight of all cultures taken in the ABP-received period (18.2%) and 25 (16.2%) of the ABP-discontinued cultures were considered to be indicative of symptomatic UTIs (P = 0.65). The multiple antibiotic resistance rate of microorganisms in cultures taken during the ABP-discontinued period (47; 30.5%) was lower than that in those taken in the ABP-received period (62; 40.3%), (P = 0.07). There was no difference between the ABP-received and ABP-discontinued periods with respect to the development of new lesions according to dimercaptosuccinic acid results (P = 0.14). Conclusion: Routine ABP usage is not protective against the development of symptomatic UTIs and new lesions in neurogenic bladder patients receiving CIC. Furthermore, the growth of resistant microorganisms increased in the ABP-received perio

Hypernatremic dehydration and renal vein thrombosis in a case with Cornelia de Lange syndrome associated with holoprosencephaly

Cornelia de Lange sendromu (CDL), mikrosefalı, sinofriz, uzun jiltrum gibi karakteristik yüz görünümü bulgularının bulunduğu, intrauterin büyüme genliği, mental ve gelişimsel gerilikle seyreden, çoğunlukla sporadik olmakla beraber otozomal dominant veya resesif kalıtım paterninin de sorumlu olabildiği bir genetik sendromdur. Beyin orta hat anomalileri bu sendroma sıklıkla eşlik etmektedir, ancak holoporozensefali ile beraberliği sık değildir. Bu yazıda, CDL sendromuna eşlik eden holoprozensefalili olguda, hipernatremik dehidratasyon, akut böbrek yetmezliği ve renal ven trombozu komplikasyonları tartışılmıştır.Cornelia de Lange syndrome (CDL) has characteristic features such as microcephaly, synophrys, long philtrum and intrauterine growth retardation, and mental and motor retardation. The syndrome is usually sporadic, although autosomal dominant and recessive inheritance might be a factor in some cases. Although midline malformations of the brain are common in CDL, holoprosencephaly is not usual. In this paper, we discussed hypernatremic dehydration and renal vein thrombosis complications in a case with CDL associated with holoprosencephaly