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

Childhood Immune Thrombocytopenia: Long-term Follow-up Data Evaluated by the Criteria of the International Working Group on Immune Thrombocytopenic Purpura

OBJECTIVE: Immune thrombocytopenia (ITP) is a common bleeding disorder in childhood, characterized by isolated thrombocytopenia. The International Working Group (IWG) on ITP recently published a consensus report about the standardization of terminology, definitions, and outcome criteria in ITP to overcome the difficulties in these areas. METHODS: The records of patients were retrospectively collected from January 2000 to December 2009 to evaluate the data of children with ITP by using the new definitions of the IWG. RESULTS: The data of 201 children were included in the study. The median follow-up period was 22 months (range: 12-131 months). The median age and platelet count at presentation were 69 months (range: 7-208 months) and 19x109/L (range: 1x109/L to 93x109/L), respectively. We found 2 risk factors for chronic course of ITP: female sex (OR=2.55, CI=1.31-4.95) and age being more than 10 years (OR=3.0, CI=1.5-5.98). Life-threatening bleeding occurred in 5% (n=9) of the patients. Splenectomy was required in 7 (3%) cases. When we excluded 2 splenectomized cases, complete remission at 1 year was achieved in 70% (n=139/199). The disease was resolved in 9 more children between 12 and 90 months. CONCLUSION: Female sex and age above 10 years old significantly influenced chronicity. Therefore, long-term follow-up is necessary in these children

Health-Related Quality of Life, Depression, Anxiety, and Self-Image in Acute Lymphocytic Leukemia Survivors

Objective: With increasing survival rates in childhood acute lymphocytic leukemia (ALL), the long-term side effects of treatment have become important. Our aim was to investigate health-related quality of life, depression, anxiety, and self-image among ALL survivors. Materials and Methods: Fifty patients diagnosed with ALL and their siblings were enrolled. The Kovacs Children’s Depression Inventory, State-Trait Anxiety Inventory, Offer Self-Image Questionnaire, and Pediatric Quality of Life InventoryTM were used for collecting data. ANOVA tests were used to determine if there were any significant differences between groups. Results: ALL survivors had higher depression, more anxiety symptoms, lower quality of life, and more negative self-image when compared to their siblings. Conclusion: Continuous diagnostic and interventional mental health services might be necessary for possible emotional side effects of treatment during and after the treatment. Rehabilitation and followup programs should be implemented for children during and after treatment for ALL

Bursa ilinde 1-16 yaş çocuklarda demir eksikliği ve demir eksikliği anemisi prevalansı

Bu çalışmanın amacı Bursa'da yaşayan 1-16 yaş arası çocuklarda demir eksikliği (DE), demir eksikliği anemisi (DEA) prevalansını belirlemek ve beslenme alışkanlıkları ve aile eğitim düzeyinin demir eksikliği anemisi gelişimine etkilerini araştırmaktır. Bu çalışma düşük sosyoekonomik bir bölgede bulunan 3 farklı aile sağlığı merkezine başvuran 1-16 yaş arası 500 sağlıklı çocukta yapılmıştır. Çalışmaya alınan çocuklar sırasıyla 1-1,9, 2-5, 6-10,9 ve 11-16 yaş grubundaki çocuklar olmak üzere dört gruba ayrıldı.Tam kan sayımı, serum demir (µg/dl), demir bağlama kapasitesi (µg/dl), ferritin (ng /ml), transferrin satürasyonu (%) çalışıldı. Araştırmaya alınan çocukların beslenme ve anne-baba eğitim durumlarını araştırmak için anket uygulandı. Bu çalışmada anemi, DE ve DEA National Health and Nutrition Examination Survey (NHANES III) kriterlerine göre araştırıldı. Mentzer indeksi talasemi minör ve DEA'yı ayırt etmek için kullanıldı. Araştırmaya alınan 247 erkek (%49) ve 253 kız (%51)olgularımızın yaş ortalaması 7,4±3,9 yıl idi. NHANES III kriterlerine göre anemi prevalansı %31(n=155) idi. Grup I ve Grup IV'te anemi görülme sıklığı diğer gruplara göre daha yüksekti(p<0.05).Araştırmadaki 500 olgunun %12'sinde (n=61) DE, %7,4'ünde (n=37) DEA bulundu. Serum ferritin seviyesi DEA'nın saptanmasında en yüksek duyarlılık ve özgüllüğe sahipti (p<0,001).Çalışmadaki 500 olgunun 18'inde (%3,6) talasemi minör saptandı. Anemik gruplarda anne eğitim düzeyi anlamlı olarak daha düşüktü(p<0.05).DE ve DEA ülkemiz için halen önemli bir sağlık sorunudur. Annelerin eğitim düzeyi çocuk beslenmesinde önemli role sahiptir. Bu sorunu çözmek için; Ebeveynler, çocuk beslenmesine yönelik eğitim programları ile desteklenmelidir