Comparison of pediatric antibiotic prescribing practice between low and high prescribers for children in primary care

Background. Antibiotic prescribing is more prevalent in children. Many factors influence this practice, including the burden of outpatient visits. We aimed to compare antibiotic prescribing for children by low prescribers (LP) and high prescribers (HP) in primary care. Methods. We analyzed pediatric prescriptions in primary care in Istanbul. Among the physicians randomly selected by systematic sampling, those generating ≥1 pediatric prescription/day (n=1218) were defined as LP or HP when they belonged to the lowest (n=305) or highest (n=304) quartile of prescribing, respectively. The antibiotic prescribing characteristics of these groups were compared. Results. We identified that 38.5% of the prescriptions written by physicians included antibiotics, significantly higher in HPs (38.8%) than in LPs (37.2%), (p=0.04). Among antibiotic-containing prescriptions, the mean number of drugs and boxes and the percentage of prescriptions containing injectable drugs/antibiotics were significantly higher in HPs compared to that in LPs. We detected that co-amoxiclav was the most frequently prescribed antibiotic in the LP and HP groups (61.1% and 48.3%, respectively). Stratification of antibiotics by their spectra showed that 11.2% were narrow, 79.8% were broad and 0.5% were ultra-broad-spectrum drugs. LPs were significantly more likely to prescribe broad-spectrum antibiotics (82.5%) than do HPs (78.9%,p<0.001). Conclusions. Antibiotic prescribing remains excessive in pediatric primary care, slightly more marked in HPs. While HPs also tend to prescribe a higher number of overall and injectable drugs/antibiotics, broad-spectrum anti-biotherapy seems to be more practiced by LPs surprisingly. Both physician groups appeared to prefer either narrow-or broad-spectrum drugs without paying enough attention to their pharmacodynamic properties

Investigation of allergy management in primary care: Child vs. adult prescriptions

Objective: Allergic diseases are conditions that are frequently encountered in primary care, and different drug groups can be used in their treatment. This study aimed to compare the use of drugs in allergy in children and adults applied to primary care. Methods: We analyzed prescriptions written by those who were selected by systematic sampling (n=1431) among family physicians serving in İstanbul between January 1 and December 31, 2016. Among these, single-diagnosis prescriptions containing “T78.4-allergy, unspecified” were included in the study, and the prescriptions were divided into those written to children (<18 years old) and adults (≥18 years old). The demographic characteristics of the patients and drug details in the prescriptions were compared according to the groups. Results: A total of 37,042 prescriptions with a single diagnosis of allergy were identified, and 55.9% of which were for adults. Allergy diagnosis was higher in men (52.4%) among children and in females (67.7%) among adults. Antihistamines (85.3% and 83.4%, p<0.001), systemic steroids (5.4% and 1.6%, p<0.001), and inhalants (1.8% and 1.3%; p<0.001) were more likely prescribed to adults, whereas topical drugs were prescribed more in children (51.7% and 42.7%, p<0.01). Monotherapy was more preferred in children (45.8%) than in adults (41.6%, p<0.0001). Although antihistamine monotherapy was similar in these groups, topical drug monotherapy was used more in children (10.3%) than in adults (5.6%). Prescriptions with first-generation antihistamines were higher in adults (6.8%) than in children (5.4%; p<0.001). Desloratadine was the most commonly encountered drug in the prescriptions of both pediatric and adult patients (21.2% and 10.3%, respectively). Conclusion: The study revealed that antihistamines, mostly second-generation agents, are frequently preferred. Apart from the higher prescription of systemic corticosteroids for adults and topical drugs for children, it is understood that the pharmacological management of allergic conditions in primary care shows overall similarities in both age groups

Bir orbital ensefaloselin tesadüfi tanısı-kapak miyokimisinin ötesi

A 38-years-old woman presented to our hospital for routine eye examination. She had no complaints but it was learnt that she has been followed up with the diagnosis of a left upper eyelid myokymia for more than 10 years in various ophthalmological centers. Since her eyelid movement was atypical for a myokymia, but in form of an orbital pulsation instead she has undergone an orbital magnetic resonance imaging (MRI) scan. She was coincidentally diagnosed to have a left frontoorbital encephalocele detected by MRI. She had no trauma or chronic illness in history, so the condition was diagnosed as a ‘congenital encephalocele’ which is lately detected since due to the absence of obvious proptosis or an active clinical complaint

Comparison of primary care prescriptions for old and very old hypertensive patients

Background/aim: Elderly and very elderly individuals might be subject to different approaches for the treatment of hypertension. We aimed to compare drug utilization in hypertensive old patients and very old patients in primary care, along with the evaluation of potentially inappropriate drug prescribing. Materials and methods: In this cross-sectional study, we compared prescriptions of 65-79-year-old (old patient prescriptions [OPP], n = 433,988) vs. >= 80-year-old (very old patient prescriptions [VOPP], n = 134,079) with "essential hypertension" diagnosis, issued by 3:1 systematically-sampled primary care physicians (n = 1431) in Istanbul throughout 2016. Drug utilization patterns and distribution of antihypertensives based on drug class and combination status were evaluated. Frequency of potentially inappropriate drugs per Beers Criteria were identified and compared. Results: Antihypertensive monotherapy practice was less common in OPP than VOPP (43.3% vs. 45.3%; p < 0.001). In both groups, the most commonly prescribed drugs were beta-blockers for monotherapy (37.4% vs. 33.1%, p < 0.001) and thiazide diuretics for combined therapy (69.8% vs. 67.4%, p < 0.001). Metoprolol was the most commonly prescribed antihypertensive both in OPP and VOPP (15.3% vs. 14.8%). Furosemide was ranked 10th in OPP and 3rd in VOPP (2.7% vs. 5.5%). Cardiovascular system drugs were the most commonly encountered potentially inappropriate medications in both groups (263.9 vs. 283.4 per 10,000 prescriptions, p = 0.004). Regarding antihypertensive drugs, 2.2% of those in OPP and 2.4% of those in VOPP were identified as potentially inappropriate (p = 0.002). Conclusion: Prescribing preferences to old and very old patients mostly showed slight differences. Almost half of prescriptions comprising antihypertensive monotherapy might imply hesitancy to prescribe combinations. Overuse of risky drugs such as furosemide in both groups, especially in the very elderly, requires more attention

The relationship between insulin resistance, metabolic syndrome and nonalcoholic fatty liver disease in non-obese non-diabetic Turkish individuals: a pilot study

Background/Aims: Nonalcoholic fatty liver disease is related to obesity, metabolic syndrome, and insulin resistance. Nonalcoholic fatty liver disease and metabolic syndrome may also be encountered in non-obese, non-diabetic individuals, and there are no published data about the prevalence of these conditions in non-obese, non-diabetic Turkish subjects. We aimed to determine the difference between non-obese, non-diabetic nonalcoholic fatty liver disease patients and healthy controls in terms of insulin resistance and metabolic syndrome in Turkish subjects. Materials and Methods: Non-obese, non-diabetic individuals (n=219) were enrolled. The cohort was divided into two groups according to presence of steatosis in ultrasonography: nonalcoholic fatty liver disease group (n=143) and healthy control group (n=76). Insulin resistance and metabolic syndrome were analyzed and compared between the two groups. Results: The prevalences of metabolic syndrome (32.2% vs. 5.3%, respectively; p<0.001) and insulin resistance (46.2% vs. 9.2%, respectively; p<0.001) were significantly higher in the nonalcoholic fatty liver disease group. According to multiple logistic regression analysis, age (odds ratio 1.534; p=0.0032), insulin resistance (odds ratio 1.074; p<0.001), and serum ALT levels (odds ratio 1.102; p<0.001) were independently associated with nonalcoholic fatty liver disease. Conclusion: Insulin resistance and metabolic syndrome are not rare in non-obese, non-diabetic Turkish subjects with nonalcoholic fatty liver disease. Ultrasonographically detected fatty liver was independently associated with insulin resistance, irrespective of the presence of metabolic syndrome

C60 and the symmetry of icosahedral

TEZ2151Tez (Yüksek Lisans) -- Çukurova Üniversitesi, Adana, 1996.Kaynakça (s. 56-57) var.iv, 59 s. ; 30 cm.

The yield prediction using artificial intelligence techniques based on image processing: Apple tree implementation

Tarım sektörü, insanlığın ekonomik ve sosyal gelişiminde çok önemli görevler üstlenmiş ve bu görevini günümüze kadar sürdürmüştür. Tarımsal üretim doğa koşullarına bağlı olduğu için risk ve belirsizlik yüksektir. Günümüzde birçok alanda teknolojik gelişmeler yaşanmıştır. Özellikle tarım alanında yapay zekânın kullanımına yönelik büyük bir gelişme gösteren bilgisayar teknolojileri sayesinde, tarımda yaşanan bu risk ve belirsizliklere daha hızlı ve tutarlı çözümler üretmek mümkün hale gelmiştir. Tarımda yaşanan risk ve belirsizliklerden biri de rekolte tahminidir. Bu tahminlerde belirsizlik yüksek olduğu için yapay zekâdan faydalanmak doğruluk oranını arttıracaktır. Bu çalışmada elma ağaçlarındaki toplam rekoltenin tahmini için yapay zekâ ve görüntü işleme tekniklerinden faydalanılmıştır. Evrişimsel sinir ağları (ESA), doğrusal regresyon (DR) ve hazırlanan bir yapay sinir ağı (YSA) modeli ile tahmin çalışması yapılmıştır. Farklı yapay zekâ modelleri ile yapılan bu çalışmaların sonucunda doğrulukları kıyaslanarak % 85 ‘in üzerinde doğruluk oranları elde edilmiştir.. The agricultural sector has undertaken significant roles in the economic and social development of humanity and has continued this task until today. Risk and uncertainty are high as agricultural production depends on natural conditions. Today, there have been technological developments in many fields. Thanks to computer technologies, which have made great progress especially in the use of artificial intelligence in the field of agriculture, it has become possible to produce faster and more consistent solutions to these risks and uncertainties in agriculture. One of the risks and uncertainties experienced in agriculture is yield estimation. Since the uncertainty in these estimates is high, making use of artificial intelligence will increase the accuracy rate. In this study, artificial intelligence and image processing techniques were used to estimate the total yield of apple trees. Estimation study was carried out with convolutional neural networks (CNN), linear regression and a prepared artificial neural network (ANN) model. As a result of these studies with different artificial intelligence models, accuracy rates of over 85 % were obtained by comparing their accuracy

Comparison of pharmacotherapy competence of good and poor prescribers in primary care

...British Pharmacological Societ

Investigation of opioid analgesic use in primary care

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Assessment of clinical features and renal functions in Coronavirus disease-19: A retrospective analysis of 96 patients

Background The most common extra pulmonary organ dysfunction in acute respiratory distress syndrome is acute kidney injury. Current data so far indicate low incidence of AKI in Covid-19 disease. Objective In this retrospective study, we analysed the clinical features of patients diagnosed with Covid-19 and investigated the effect of Covid-19 on kidney function. Methods Ninety-six patients diagnosed with Covid-19 were included in our study. Demographic features (Age, gender, co-morbidities), symptoms, thorax CT findings, Covid-19 PCR results and laboratory findings were recorded. The clinical features of the patients were analysed and kidney function values before Covid-19 diagnosis were compared with kidney function values after Covid-19 diagnosis. Results Most presenting symptom was fever (51%). Most accompanying co-morbidity was hypertension (56%). According to laboratory findings; ferritin, D-dimer and C-reactive protein levels were statistically significantly higher in ARDS group than severe pneumonia and pneumonia group (P = .002,P = .001 andP < .001, respectively). Also lymphocyte levels were statistically significantly lower in ARDS group than severe pneumonia and pneumonia group (P = .042). According to KDIGO criteria 3 (3.1%) patients had AKI during the hospital stay. For all patients, there was statistically significant difference between basal, 1st, 5th and 10th day BUN and SCr levels (P = .024 andP = .018, respectively). For severe pneumonia group there was statistically significant difference between basal, 1st, 5th and 10th day SCr levels (P = .045). Conclusion Our study demonstrated that Covid-19 can cause renal impairment both with pneumonia and ARDS. A large-scale prospective randomised studies are needed to reach final judgement about this topic